Probiotics in primary prevention of atopic diseases

ABSTRACT

The present invention is in the field of prophylaxis of allergies, and relates specifically to primary prevention of atopic diseases by administering probiotic bacteria, beneficial microbes of the healthy gut flora, pre- and postnatally to children at high risk of atopic diseases. In an embodiment, probiotic bacteria are administered to a pregnant woman at least two weeks before infant delivery and after delivery, probiotic bacteria are administered to the newborn infant for at least two months. The amount of probiotic bacteria administered is about 1×10 8  to about 1×10 10  colony forming units of the probiotic bacteria.

This application is the national phase under 35 U.S.C. § 371 of PCTInternational Application No. PCT/FI01/00588 which has an Internationalfiling date of Jun. 20, 2001, which designated the United States ofAmerica.

FIELD OF THE INVENTION

The present invention is in the field of prophylaxis of allergies, andrelates specifically to primary prevention of atopic diseases byadministering probiotic bacteria, beneficial microbes of the healthy gutflora, pre- and postnatally to children at high risk of atopic diseases.

BACKGROUND OF THE INVENTION

At present allergy, manifested as atopic diseases—atopic eczema,allergic rhinitis and asthma—represents a chronic disorder of risingimportance in economically developed countries world-wide. Thedemonstration of an inverse association between infections early in lifeand atopy represents a substantial advance which has led to renewedscientific interest in the hygiene hypothesis introduced a decade ago,according to which the recent rapid increase in atopy may in fact be dueto improved hygiene and reduced family size. Recent epidemiologicalstudies have yielded results both for and against this hypothesis.

Gastrointestinal microflora promote processes with a potential tocounter allergy: 1) T helper 1-type immunity, 2) generation oftransforming growth factor-β (TGF-β), which has a vital role both in thesuppression of Th2-induced allergic inflammation and in induction oforal tolerance and 3) IgA production, an indispensable component in themucosal immune defence (Sanfilippo et al., 2000; Isolauri et al., 2000).The gut microflora may thus represent a major postnatalcounter-regulator of the universal Th2-skewed immune system of pregnancyand neonatal age. Confrontation with microbial antigens in thegastrointestinal tract begins instantly after birth, and the viablecells of a fully established gut microflora outnumber those of the hostby a factor of ten. Consequently, commensal gastrointestinal microbesconstitute the earliest and most substantial stimulus for thedevelopment of gut-associated lymphoid tissue.

Probiotics, defined as live microbial food ingredients beneficial tohealth, are normal commensal bacteria of the healthy human gutmicroflora. The most frequently used genera are lactobacilli andbifidobacteria. Probiotics are known to reverse the increased intestinalpermeability characteristic of children with atopic eczema and foodallergy, and to enhance gut-specific IgA responses, frequently defectivein children with food allergy (Isolauri et al, 1993; Majamaa andIsolauri, 1996; Isolauri, 1992). Promotion of gut barrier function bymeans of probiotics also includes normalization of the gut microecology,alterations in which have been demonstrated in allergic subjects. Recentstudies indicate that certain probiotics alleviate changes related toallergic inflammation both in vitro and in vivo (Isolauri et al., 2000;Majamaa and Isolauri, 1997). A probiotic strain, Lactobacillus casei,ssp. rhamnosus (Lactobacillus GG; ATCC 53103), has been proven safe atan early age and effective in the treatment of allergic inflammation andfood allergy. Specific strains in the gut indigenous microflora thusexert profound effects on the physiology and immunology of the host.

At birth the human gastrointestinal tract is sterile, but during thefirst months and years of life a rapid sequential colonization occurs,leading to stable indigenous gut microflora. Simultaneously, theuniversally Th2-dominant immunity of newborns is intensified in atopicindividuals, with the subsequent expression of atopic disease. Inaddition to normal microflora impacting on the neonatal gastrointestinalsystem, another massive and constant antigen source is confronted in theform of dietary antigens. Recent animal studies indicate that these maypotentiate atopic-type immunity at both mucosal and systemic level. Anyprocess designed to counter-regulate allergy must thus exert its majoreffects in infancy, and preferably during the initial encounters withdietary antigens. Here probiotics are eminently appropriate for thetask, not only as regards timing but also in their capacity to reducethe dietary antigen load by degrading and modifying macromolecules(Pessi et al., 1998).

SUMMARY OF THE INVENTION

In the present application we clinically demonstrate that specificprobiotics substantially reduce the prevalence of atopic eczema, whichindicates that such microbes prevent atopic disease. On the other hand,further data obtained in our gut colonisation studies withbifidobacteria, presented in this application, demonstrate thatdifferences in gut microflora precede the development of atopy. Based onthe data we propose that exposure to specific strains of commensalmicroflora represents a key protective modular of immunity against atopyand subsequent atopic diseases and, consequently, that probioticspromoting early bifidogenic gut microflora have a preventive potentialin allergy.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 shows the profile of the Lactobacillus GG trial.

FIG. 2 shows the geometric mean concentrations of total IgE antibodiesduring the first two years of life in healthy children (open circle) andchildren with atopic eczema at the age of two years (closed circle).Error bar represents 95% confidence interval. *p=0.009 and †p=0.02,children with atopic eczema vs. healthy children (unpaired t-test).

FIG. 3 shows a dendrogram representing relative similarities ofbacterial fatty acid profiles in faecal samples analysed by gas-liquidchromatography on a scale from 0 to 100 between samples from atopics andnon-atopics at 3 weeks and 3 months.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a method for primary prevention of atopicdiseases in an infant at high risk of such diseases, in which method toa pregnant woman a daily dose of live probiotic bacteria is administeredfor at least two weeks before delivery and, after delivery, a daily doseof live probiotic bacteria is administered to the newborn infant for atleast 2 months.

After delivery, the probiotic bacteria can be administered via thebreastfeeding mother, or directly to the newborn infant. Any daily doseof the bacteria giving a desired effect can be used, a suitable dose isabout 1×10⁸ to about 1×10¹⁰ colony forming units of probiotic bacteria.

Consequently, the invention also relates to the use of probioticbacteria for the preparation of a composition useful for primaryprevention of atopic diseases in an infant at high risk of atopicdiseases, to be administered according to the pattern as indicatedabove.

Probiotic bacteria which can be used in this invention are for instancelactic acid bacteria or bifidobacteria. A suitable lactic acid bacterialstrain is Lactobacillus casei ssp. rhamnosus (ATCC 53103), and anappropriate bifidobacterial strain is Bifidobacterium lactis Bb-12. Alsoother bacterial strains can be used, to which probiotic characteristicshave been shown.

Further, a mixture of lactic acid bacteria and bifidobacteria can beadministered.

Preferred probiotics for the purposes of this invention are probioticbacteria which have the characteristics of promoting early bifidogenicgut microflora. Such probiotics strengthen the integrity of the gut andincrease the proportion of bifidobacteria in gut microflora.

By administering probiotic bacteria according to the present inventionto an infant at high risk, in order to primarily prevent atopic disease,the intestinal flora of the infant is affected propitiously. Whilestarting the treatment during the mother's pregnancy, the amount ofprotective factors, such as antiinflammatory cytokines, of breast milkwill be increased. By prevention of an allergic inflammatory state inthis way, it is possible to prevent the breaking out of an atopicdisease.

The expression “primary prevention” used in the present applicationmeans a prophylactic treatment for the purpose of totally preventing thebreaking out of a disease in a subject at risk. On the other hand, theexpression “secondary prevention” used in the art is understood toinclude means for preventing or alleviating the symptoms of an allergicdisease already broken out or developed, e.g. preventing food allergy byeliminating the allergising food ingredients from the diet.

The present study is the first prospective clinical demonstration of aspecific microbe preventing atopic disease, and the new insight mayprovide an excellent opportunity to devise strategies against allergy.

In the present study Lactobacillus GG (ATCC 53103) was introducedprenatally via mothers and postnatally for 6 months to infants at highrisk of atopic diseases in a double-blind, randomized placebo-controlledtrial of prevention of atopic disease.

One inclusion criterion for the study was a family history of atopicdisease, i.e. one or more family members (mother, father and/or oldersibling) with atopic eczema, allergic rhinitis or asthma. Families wererecruited in antenatal clinics in the City of Turku (population 170 000)between February 1997 and January 1998, during a year, to avoid theeffect of birth month on atopic sensitization. Altogether 159 motherswere randomized by means of a computer to receive two capsules ofplacebo (microcrystalline cellulose) or 1×10¹⁰ colony-forming units ofLactobacillus GG (Valio Ltd, Finland) once a day for 2 to 4 weeks beforedelivery. After delivery breastfeeding mothers had the option ofconsuming capsules themselves, or otherwise the agents were introducedinto the diets of the infants. In the latter case, the contents of thecapsule were administered by spoon after mixing in water. Both of thesemodes of administration, via mother or to infant, have been shown toresult in comparable amounts of Lactobacillus GG in infant feces(Majamaa and Isolauri, 1997). Lactobacillus GG and placebo capsules andtheir contents looked, smelled and tasted identical. Capsules wereconsumed for 6 months postnatally. Codes were kept by the supplier untilall data were collected and analyzed. The study was approved by theCommittees on Ethical Practice in Turku University Hospital and theHealth Office of the City of Turku. Written informed consent wasobtained from the children's parents.

The children were clinically and immunologically examined during theneonatal period and on subsequent study visits at the ages of 3, 6, 12,18 and 24 months of life. A physical examination, always undertaken bythe same physician, included inspection of eyes, ears, nose and skin,auscultation of heart and lungs, palpation of abdomen, and evaluation ofgrowth and neurological development. Parents were asked about theirinfant's signs and symptoms possibly related to atopic diseases (skin:redness, dryness, oozing, scratching (itch); eyes and nose: redness,discharge, sneezing, rubbing (itch); lungs: cough, wheeze, shortness ofbreath). The assays for serum total IgE and specific IgE antibodies tomilk, egg, cat and house dust mite were carried out with Pharmacia CAPFEIA immunoassay on UniCAP 100 automatic analyzer (Pharmacia & Upjohn,Uppsala, Sweden) according to manufacturer's instructions. Anantigen-specific IgE value of more than 0.35 kU/l was consideredincreased. Skin prick test reactions were read at 10 minutes, and halfof the histamine dihydrochloride (10 mg/ml; ALK Abellò, Horsholm,Denmark; ALK) reaction size (2+) or more was recorded as positive on thecondition that the mean diameter of the wheal was at least 3 mm and thenegative control (ALK) at the same time was 0 mm. Antigens testedincluded milk containing 1.5% fat, wheat flour diluted 1:10 (w/v) with0.9% (w/v) sodium chloride, rye flour diluted 1:10 (w/v) with 0.9% (w/v)sodium chloride, gliadin diluted 1:1000 (w/v) with 0.9% (w/v) sodiumchloride, egg white (ALK), cod (ALK), soya bean (ALK), latex(Stallergens, France), birch (ALK), six local grasses (all from ALK),cat (ALK), dog (ALK) and Dermatophagoides pteronyssimus allergen Der p1(ALK). In addition, banana, potato and carrot were tested by prick-pricktechnique. Skin prick results were considered positive if an infantmanifested at least one positive reaction to the antigens tested.

Chronic recurring atopic eczema at the age of two years was consideredthe primary endpoint, since it represents the principal manifestation ofatopic diseases during the first years of life. The subjects weregrouped as suffering from this disorder (children with atopic eczema) ornot (healthy children). Atopic eczema was confirmed if the followingfeatures were detected: pruritus, facial and/or extensor involvement,and chronic relapsing course. The last-mentioned criterion was fulfilledif there was manifest eczema with a duration of one month or longer atthe 24 month study visit and on at least one previous visit. The fourthmajor criterion, a family history of atopic disease, was one inclusioncriterion for the study. The diagnosis of allergic rhinitis wasestablished if two or more subsequent symptoms were experienced on mostdays: nasal discharge, blockage, sneezing, and itching. A temporalrelationship of these symptoms with allergen exposure, relief ofsymptoms upon antihistamine treatment and evidence of atopicsensitization (i.e. positive skin prick test and/or positiveradioallergosorbent assay) were sine qua non. The diagnosis of asthmawas based on an algorithm created by an international pediatric asthmaconsensus group. Asthma was diagnosed if an infant had chronic orrecurrent cough, wheeze and/or shortness of breath suggestive of asthma,and if alternative diagnoses were excluded, and if trial antiasthmatreatment was effective.

The base-line characteristics of the study subjects were similar in theplacebo and Lactobacillus GG groups (Table 1). A total of 132/159 (83%)subjects completed the 2-year study. With at least 56 subjects in bothgroups an absolute risk reduction of 25% (50% risk in the placebo groupand 25% in the Lactobacillus GG group) in the prevalence of atopicdisease could be detected at a 5% level of significance with 80% power.The respective discontinuation rates were comparable (FIG. 1).

Atopic eczema was diagnosed in 46/132 (35%) children at the age of twoyears. Five of these children also fulfilled the diagnostic criteria forasthma and one for both asthma and allergic rhinitis. The duration ofbreastfeeding was comparable between infants manifesting atopic eczema,7.0 (5.8 to 8.2) months, and those without 6.7 (5.9 to 7.5) months; mean(95% CI) (p=0.65 by unpaired t-test). The age at the onset of symptomsof atopic eczema was 4.9 (3.9 to 6.2) months; geometric mean (95% CI).The objective SCORAD at the age of 24 months was 10 (9 to 11) inchildren with atopic eczema; geometric mean (95% CI). In children withatopic eczema the progressive IgE concentrations became manifested bythe age of two years (FIG. 2). Skin prick test reactivity to commonenvironmental antigens was more common in children with atopic eczemathan in healthy children at the ages of 12 and 24 months (p=0.03 andp=0.01, respectively by χ² test) while the frequency of increasedantigen-specific IgE concentrations in serum was comparable between thegroups (p=0.22 and 0.31, respectively by χ² test). The most commonantigens eliciting positive reactions by either method were egg and cowmilk.

The prevalence of atopic eczema was reduced to half in infants given theprobiotic, 15/64 (23%), as compared with that in those receivingplacebo, 31/68 (46%) (p=0.008 by χ² test). The number needed to treatwith 95% CI was 4.5 (2.6 to 15.6).

Most mothers, 28/43 (65%), in the probiotic group breastfeeding for atleast 6 months chose the option of consuming the probiotic capsulesthemselves. The preventive effect did not depend on the mode ofadministration, since in the Lactobacillus GG-intervention group atopiceczema was diagnosed in 9/36 (25%) cases if the infants consumed thepro-biotic themselves and in 6/28 (21%) cases if the strain was consumedby the breastfeeding mothers (p=0.74 by χ² test). The preventive effectof Lactobacillus GG was most marked in children already evincing IgEantibodies in cord blood; 3/20 (15%) infants with detectable IgE in cordblood receiving Lactobacillus GG developed atopic eczema as comparedwith 9/19 (47%) receiving placebo; relative risk 0.32 (0.10 to 0.99)(p=0.03 by χ² test). The concentration of total IgE and the frequenciesof increased antigen-specific IgE concentrations and of positivereactions in skin prick tests were comparable between infants whoconsumed the probiotic and those receiving the placebo (Table 2). Thefrequency of cases with high total IgE concentration (>93.3 kU/l) tendedto be lower in the probiotic, 11/61 (18%), than in the placebo group,17/63 (27%), at two years; relative risk (95% CI) 0.67 (0.34 to 1.29).The total IgE concentration was rated high, if greater than thegeometric mean concentration of total IgE+ one standard deviation inchildren without atopic disease.

TABLE 1 Comparison of base-line characteristics of the study subjectsPlacebo group Lactobacillus GG (n = 82) group (n = 77) Family history:Maternal atopic disease 63/82 (77%) 55/77 (71%) Older sibling 30/82(37%) 26/37 (34%) Parent(s) smoking 17/82 (21%) 9/77 (12%) Furry pet athome 9/82 (11%) 16/77 (21%) Birth characteristics: Weeks ofgestation^(a)) 39.4 (39.0 to 39.7) 39.4 (39.0 to 39.7) Male gender 43/82(52%) 49/77 (64%) Cord blood IgE (kU/l)^(b)) 0.04 (0.02 to 0.06) 0.06(0.03 to 0.12) Head circumference (cm)^(a)) 35.0 (34.7 to 35.3) 35.2(34.8 to 35.5) Weight (g)^(a)) 3610 (3510 to 3720) 3630 (3520 to 3740)Values are numbers (percentages) of cases of maternal atopic disease,older sibling, parent/s who smoke/s and furry pet at home ^(a))Valuerepresents mean (95% confidence interval) ^(b))Value representsgeometric mean (95% confidence interval)

TABLE 2 Atopic sensitization in the intervention groups Placebo groupLactobacillus GG (n = 68) group (n = 64) p-value Total IgE (kU/I)^(a)):3 months 3.0 (2.4 to 3.7) 3.1 (2.5 to 4.0) 0.79^(d)) 12 months 9.7 (7.0to 13.4) 11.2 (8.0 to 15.7) 0.55^(d)) 24 months 32.7 (22.6 to 47.3) 31.3(22.8 to 43.0) 0.85^(d)) Increased RAST readings^(b)): 3 months 2/66(3%) 2/58 (3%) 0.90^(e)) 12 months 15/66 (23%) 16/62 (26%) 0.68^(e)) 24months 16/64 (25%) 17/62 (27%) 0.76^(e)) Prick test reactivity^(c)): 6months 7/68 (10%) 11/64 (17%) 0.25^(e)) 12 months 12/68 (18%) 17/63(27%) 0.20^(e)) 24 months 9/65 (14%) 11/61 (18%) 0.52^(e)) ^(a))Valuerepresents the geometric mean (95% confidence interval) Value representsthe numbers (percentages) of infants evincing at least ^(b))oneincreased (>0.35 kU/l) antigen-specific IgE concentration inradioallergosorbent (RAST) assay or ^(c))one positive reaction in skinprick testing. ^(d))Unpaired t-test and^(e) X2 test (placebo vs. Lactobacillus GG))The Gut Colonisation Studies

In the studies with bifidobacteria we prospectively followed 76high-risk infants from birth to the age of one year, when thedevelopment of atopic sensitisation was determined by skin pricktesting. Since the major and primary microbial stimulation occurs alongwith the establishment of the gut microflora, we hypothesised thatexposures to commensal microflora outnumber sporadic infections and thatthis may be related to other changes predisposing to atopy, thusrepresenting a key modulator of the immune system in the newborn.

Research on the gastrointestinal microflora by conventional bacterialculture has been hampered by the lack of sensitivity in methods ofassessment, as almost half of the bacteria in the gut are unculturable,if nonetheless viable. We therefore utilised, in addition to bacterialcultivation, two culture-independent methods: gas-liquid chromatography(GLC) of bacterial cellular fatty acids and quantitative fluorescence insitu hybridisation (FISH) of bacterial cells to characterise the gutmicroflora during the first months of life in infants later developingor not developing atopy.

Subjects and Study Design

The study cohort comprised 76 volunteer families with 76 newborninfants, randomly selected from the population of an allergy-preventionstudy evaluating the preventive potential of probiotics in atopy. Inthis study population 30/76 (39%) infants had one and 46/76 (61%)several first-degree close relatives with atopic eczema, allergicrhinitis or asthma.

The study was approved by the Committees on Ethical Practice in TurkuUniversity Central Hospital and the Health Office of the City of Turku.Written informed consent was obtained from the children's parents.

The infants were born between the 36^(th) and 42^(nd) weeks of gestation(mean 40). They were clinically examined at the ages of 2 days, 3 weeks,and 3, 6 and 12 months. Any signs and symptoms of atopic disease wererecorded. Atopic sensitisation at the age of 12 months, evaluated byskin prick testing, was considered a primary endpoint. Infants wereconsidered atopics if they evinced at least one positive reaction to theantigens tested, whereas those without positive reaction were considerednon-atopics. Double-blind placebo-controlled cow milk challenge wasapplied when symptoms, clinical signs or skin prick tests weresuggestive of cow milk allergy.

Diagnosis of Atopic Dermatitis

The diagnosis of atopic dermatitis was based on criteria previouslydescribed (Hanifin, 1991). Briefly, atopic dermatitis was confirmed ifthe following three major features were detected: pruritus, typicalmorphology and distribution, and chronic dermatitis (duration of onemonth or longer).

Evaluation of Atopic Sensitisation

Atopic sensitisation was evaluated by skin prick testing as previouslydescribed (Majamaa and Isolauri, 1997). Reactions were read at 10minutes, and half of the histamine dihydrochloride (10 mg/ml; ALKAbellò, Horsholm, Denmark; ALK) reaction size (2+) or more was recordedas positive on the condition that the mean diameter of the wheal was atleast 3 mm, and the negative control (ALK) at the same time was 0 mm.Antigens tested included milk containing 1.5% fat, wheat flour diluted1:10 (w/v) with 0.9% (w/v) sodium chloride, rye flour diluted 1:10 (w/v)with 0.9% (w/v) sodium chloride, gliadin diluted 1:1000 (w/v) with 0.9%(w/v) sodium chloride, egg white (ALK), cod (ALK), soybean (ALK), latex(Stallergens, France), birch (ALK), six local grasses (ALK), cat (ALK),dog (ALK) and Dermatophagoides pteronyssimus allergen Der p1 (ALK). Inaddition, banana, potato and carrot were tested by prick-pricktechnique.

Diagnosis of Cow Milk Allergy

The diagnosis of cow milk allergy was based on an unambiguousrelationship between ingestion of cow milk and clinical symptoms, i.e.the symptoms disappeared after elimination of cow milk from the diet,and an unequivocal relapse occurred in a double-blind,placebo-controlled cow milk challenge. This challenge was carried out asdescribed elsewhere (Kalliomäki et al, 1999).

Cultivation of Stool Samples

A faecal sample from the infant was taken either by nursing staff atscheduled visit or immediately prior to it by parents. In the lattercase, the sample was stored at 4° C. and delivered to the hospitalwithin 24 hours for immediate cultivation. A stool sample was obtainedfrom 71 infants at the age of 20 days (18 to 21 days) and from 69 at theage of 14 weeks (13 to 14 weeks); mean (95% CI). The rest of the samplewas immediately frozen and stored at −20° C. until analysed by GLC andFISH. No quantitative culture methods were employed. The bacteria werecultured on 6 different freshly prepared media, i.e. Blood Agar(Pronadisa, Madrid, Spain) for gram-negative rods; agar (Leiras, Turku,Finland) supplemented with Mycological Peptone (Oxoid, Basingstoke,United Kingdom) and glucose for yeasts and fungi; Bile Eskulin AzideAgar (Difco, Detroit, USA) for enterococci; Blood Agar (Pronadisa)supplemented with glucose, yeast extract (LAB M, Bury, United Kingdom),L-cysteine HCl (Merck, Darmstadt, Germany), metadion (Merck) andneomycin sulfate (Sigma, St. Louis, USA) for anaerobes; Clostridiumdifficile Agar (Oxoid) supplemented with hemin (Sigma), neutralred(Merck), D-Cycloserine (Sigma), egg and Cefoxitin (MSD, Haarlem, theNetherlands) for Clostridium difficile; and Rogosa SL agar (Difco) forLactobacillus-like bacteria. The first three media were incubatedaerobically and the last three anaerobically at 35° C. for 48 h.Subsequently, identification of different species was made according totheir growth on selective media, colonies, color and cell morphology.

Gas-Liquid Chromatography of Bacterial Fatty Acids

The method has previously been described in detail (Eerola and Lehtonen,1988). After separation of bacterial material from faecal vegetablefibres and free fatty acids, the sample was remixed and allowed tosediment for 15 min. Thereafter the bacterial component was isolated bycentrifuging at 1000 g for 15 min at room temperature and removing thesupernatant. The collected bacterial mass was saponified and methylated.The methylated fatty acids were then extracted with ethyl ether andhexane. GLC analysis was performed with an HP5890A gas chromatograph(Hewlett-Packard) and an Ultra 2004-11-09B fused silica capillary column(0.2 mm by 25 m; cross-linked 5% phenylmethyl silicone;Hewlett-Packard). A recently developed computerised bacterialidentification program was used to analyse the GLC profiles of thefaccal samples. The analysis was based on the correlation and clusteranalysis of the fatty acid spectra of individual samples. All peaks ofindividual fatty acids in the chromatograms were used in comparisons.

Fluorescence In Situ Hybridization of Bacterial Cells

Faecal samples were suspended in 0.1M phosphate buffered saline (pH 7.0)to give a final concentration of 10% (w/v). The slurries werehomogenized and centrifuged at low power (250 g for 2 min) to removeparticulate matter. Bacterial cells were fixed and FISH performed aspreviously described (Langendijk et al., 1995). In brief, cells werefixed overnight in 4% (v/v) paraformaldehyde at 4° C., washed twice inPBS and stored at −20° C. in a PBS:ethanol (1:1) solution. Subsamples ofthe fixed cells were hybridised overnight in hybridisation buffer with 5ng×μL⁻¹ Cy3 indocarbocyanin-labelled oligonucleotide probe. Probesincluded were Bac303 (CCAATGTGGGGGACCTT)(SEQ ID NO: 1) specific forbacteroides, Bif164 (CATCCGGCATTACCACCC)(SEQ ID NO: 2) forbifidobacteria, His150 (TTATGCGGTATTAATCT(C/T)CCTTT)(SEQ ID NO: 3) forclostridia and Lab158 (GGTATTAGCA(T/C)CTGTTTCCA)(SEQ ID NO: 4) forlactobacilli and enterococci; (sequence 5′→3′). Total cell numbers werecounted using a nucleic acid stain 4′,6-diamidino-2-phenylindole (DAPI).Cells were washed with the hybridisation buffer, filtered through a 0.2μm polycarbonate filter (Millipore Corporation, Bedford, USA) andmounted on a slide with SlowFade® (Molecular Probes Inc., Eugene, USA).They were counted visually using a Leica Laborlux D epifluorescencemicroscope mounted with Cy3 and DAPI specific filters. Fifteenmicroscopic fields were counted per assay.

Statistics

Normally distributed data are expressed as means with 95% confidenceinterval (CI) and those of skewed distribution as geometric means with95% CI after logarithmic (log) transformation. Unpaired t-test wasapplied to compare values between the groups. The χ²-test was used tocompare proportions between the groups.

The entire analysis of the GLC data was based on paired comparisonsbetween individual samples and calculation of similarity indices betweenthem. Similarity indices were presented as correlation matrices andfurther analysed by weighted pair-group cluster analysis of arithmeticmeans. The faecal samples were divided into four different groups foranalysis of the results of GLC of bacterial cellular fatty acidsaccording to the atopic status of the infant (atopic vs. non-atopic) andsampling time (age 3 weeks vs. 3 months). Statistical significancebetween atopics and non-atopics at different time points was calculatedby comparing the variation in fatty acid profiles within the groups tothat between the groups. The within-group variation was determined bycalculating the mean (SD) of the similarity indices of all pairedcomparisons within the group. That between two different groups wasobtained by calculating the mean (SD) of all paired similarity indicesbetween samples in both groups. Subsequently, the inter-group variationwas compared with that within the groups by calculating a Z-value aspreviously described. The Z-value was used to determine the p-value bymeans of a Z-table. P<0.05 was considered statistically significant.

RESULTS

Atopic Sensitisation and Clinical Characteristics

At the age of 12 months atopic sensitisation was observed in 22/76 (29%)children. Skin prick test reactivity to egg, cow milk, wheat, cat andlatex was seen in 19/22 (86%), 5/22 (23%), 3/22 (14%), 2/22 (9%) and1/22 (5%) atopics, respectively. No skin prick reactivity to any otherantigen tested was seen. Five atopics were polysensitised, i.e. theyevinced positive skin prick test reactivity to at least two differentantigens. Half of the atopics, 11/22 (50%), manifested atopic dermatitisand 9/22 (41%) were allergic to cow milk as diagnosed by double-blindplacebo-controlled cow milk challenge.

A maternal atopic history was observed in 19/22 (86%) atopics and 45/54(83%) non-atopics (p=0.74). Atopics and non-atopics were comparable forbirth characteristics. The means of length, weight and headcircumference at birth were 51.2 (50.3 to 52.8) cm, 3600 (3410 to 3790)g and 35.1 (34.5 to 35.7) cm, respectively, in atopics and 50.6 (50.1 to51.1) cm, 3610 (3480 to 3740) g and 35.1 (34.7 to 35.5) cm,respectively, in non-atopics (p=0.24, p=0.94, p=0.98, respectively);mean (95% CI).

At the ages of 3 weeks and 3 months dietary characteristics werecomparable between atopics and non-atopics (Table 3). At 3 months 9/54(17%) non-atopics but none of the atopics had received antibiotics,p=0.04.

Neonatal Gastrointestinal Microflora

According to bacterial cultivation, there were no differences inneonatal gut microflora between infants developing and not developingatopy (Table 4). At the same time, however, there was a statisticallysignificant difference between the groups in the bacterial cellularfatty acid profile of stool samples (FIG. 3) (p=0.005). In order todetect the bacteria possibly responsible for the discrepancy, FISH offaecal bacteria was applied to 29 samples; the results demonstrated thatthe ratio of bifidobacteria to clostridia was reduced in atopics, 19 (3to 122), as compared to that in non-atopics, 185 (57 to 604); geometricmean (95% CI) (p=0.03). The difference was caused by a tendency towardslower counts of bifidobacteria and higher counts of clostridia inatopics (Table 5).

Gastrointestinal Microflora at the Age of 3 Months

There were no statistically significant differences in gut microflorabetween atopics and non-atopics at the age of 3 months. The respectivebacterial cellular fatty acid spectra were comparable (FIG. 3). Nor didresults of bacterial cultivation differ between the groups, althoughnon-atopics tended to have yeasts in their stools more frequently thanatopics (Table 4) (p=0.07).

TABLE 3 Dietary characteristics and use of antibiotics in infants at 3weeks and 3 months Atopics^(a)) Non-atopics^(a)) (n = 22) (n = 54)x²-test 3 weeks: exclusively breastfed 16/22 (73%) 37/54 (68%) 0.31partially breastfed 6/22 (27%) 15/54 (28%) 0.96 totally bottlefed 0/222/54 (4%) 0.36 antibiotics^(b)) 0/22 3/54 (6%) 0.26 3 months:exclusively breastfed 11/22 (50%) 29/54 (54%) 0.77 partially breastfed6/22 (27%) 14/54 (26%) 0.90 totally bottlefed 5/22 (23%) 11/54 (20%)0.82 antibiotics^(c)) 0/22 9/54 (17%) 0.04 ^(a))Infants with at leastone positive reaction in skin prick testing were considered atopic,those without non-atopic. ^(b)) and ^(c))represent the number of infantshaving received systemic antibiotics (orally or intravenously) by theages of 3 weeks and 3 months, respectively

TABLE 4 Cultured faecal microflora in infants at 3 weeks and 3 monthsYeasts and Gram-neg Clostridium Entero- fungi^(a)) rods^(a))Anaerobics^(a)) difficile ^(a)) Lacto- bacilli^(a)) 3 weeks:Atopics^(b)) 0/20 15/20 18/20 0/20 16/20 18/20 Non-atopics^(b)) 45/512/51 39/51 45/51 2/51 41/51 χ²-test 0.37 0.90 0.83 0.37 0.97 0.83 3months: Atopics^(b)) 0/20 20/20 18/20 1/20 18/20 20/20 Non-atopics^(b))47/49 7/49 45/49 40/49 6/49 44/49 χ²-test 0.07 0.19 0.39 0.37 0.98 0.36^(a))Numbers in columns represent the number of infants having thebacterium/bacteria in faecal sample analysed by bacterial cultivation^(b))Infants with at least one positive reaction in skin prick testingwere considered atopic, those without non-atopic.

TABLE 5 Bacterial counts in faecal samples analysed by fluorescence insitu hybridisation at the age of 3 weeks Un- paired Atopics^(a))Non-atopics^(a)) t-test^(c)) Clostridia^(b)) 9.3 (3.8 to 22.9) × 10⁷ 3.3(1.8 to 6.1) × 10⁷ 0.04 Bifidobacteria^(b)) 1.8 (0.4 to 7.6) × 10⁹ 6.1(2.5 to 14.6) × 10⁹ 0.11 Lactobacilli/ 2.4 (1.1 to 5.2) × 10⁸ 3.4 (1.5to 7.6) × 10⁸ 0.53 enterococci^(b)) Bacteroides^(b)) 1.1 (0.3 to 4.4) ×10⁸ 0.5 (0.2 to 1.4) × 10⁸ 0.30 Total cell 8.9 (4.0 to 19.4) × 10⁹ 9.6(5.3 to 17.3) × 10⁹ 0.87 count^(b)) ^(a))Infants with at least onepositive reaction in skin prick testing were considered atopic, thosewithout non-atopic. ^(b))represents the geometric mean (95% CI) offaecal number of bacteria/g. ^(c))Unpaired t-test was applied afterlogarithmic transformation of bacterial counts.

REFERENCES

-   Eerola E, Lehtonen O P. Optimal data processing procedure for    automatic bacterial identification by gas-liquid chromatography of    cellular fatty acids. J. Clin. Microbiol. 1988; 26:1745–1753.-   Hanifin J M. Atopic dermatitis in infants and children. Pediatr.    Clin. North Am. 1991; 38:763–789.-   Isolauri E, Suomalainen H, Kaila M, et al. Local immune response in    patients with cow milk allergy: follow-up with patients retaining    allergy or becoming tolerant. J. Pediatr. 1992; 120:9–15.-   Isolauri E, Arvola T, Sütas Y, Moilanen E., Salminen S. Probiotios    in the management of atopic eczema. Clin. Exp. Allergy 2000;    30:1605–1610.-   Isolauri E, Majamaa H, Arvola T. et al. Lactobacillus casei strain    GG reverses increased intestinal permeability induced by cow milk in    suckling rats. Gastroenterology 1993; 105: 1643–1650.-   Kalliomäki M, Ouwehand A, Arvilommi H, Kero P, Isolauri E.    Transforming growth factor-beta in breast milk: a potential    regulator of atopic disease at an early age. J. Allergy Clin.    Immunol. 1999; 104:1251–1257.-   Langendijk P S, Schut F, Jansen G J, Raangs G C, Kamphuis G R,    Wilkinson M H, et al. Quantitative fluorescence in situ    hybridization of Bifidobacterium spp. with genus-specific 16S    rRNA-targeted probes and its application in fecal samples. Appl.    Environ. Microbiol. 1995; 61:3069–75.-   Majamaa H, Isolauri E. Evaluation of the gut mucosal barrier:    evidence for increased antigen transfer in children with atopic    eczema. J. Allergy Clin. Immunol. 1996; 97: 985–990.-   Majamaa H, Isolauri E. Probiotics: a novel approach in the    management of food allergy. J. Allergy Clin. Immunol. 1997;    99:179–185.-   Pessi T, Sütas Y, Marttinen A, Isolauri E. Down-regulation of    anti-CD3 antibody-induced IL-4 production by bovine caseins    hydrolysed with Lactobacillus GG-derived enzymes. J. Nutr. 1998;    128: 2313–2318.-   Sanfilippo L, Li C K, Seth R, Balwin T J, Menozzi M G, Mahida Y R.    Bacteroides fragilis enterotoxin induces the expression of IL-8 and    transforming growth factor-beta (TGF-beta) by human colonic    epithelial cells. Clin. Exp. Immunol. 2000; 119:456–463.

1. A method for prevention of atopic diseases selected from the groupconsisting of atopic eczema, allergic rhinitis and asthma in an infantat high risk of said atopic diseases, comprising administering to apregnant woman a daily dose of live probiotic bacteria in an amount ofabout 1×10⁸ to about 1×10¹⁰ colony forming units of the probioticbacteria for at least two weeks before infant delivery, and after infantdelivery, administering directly to the newborn infant of said pregnantwoman a daily dose of live probiotic bacteria in an amount of about1×10⁸ to about 1×10¹⁰ colony forming units of the probiotic bacteria forat least 2 months; wherein said probiotic bacteria are selected from thegroup consisting of Lactobacillus casei spp. rhamnosus ATCC 53103 andBifidobacterium lactis Bb-12.
 2. The method according to claim 1,wherein the administering of said live probiotic bacteria to saidpregnant woman and to said newborn infant results in promoting earlybifidogenic gut microflora.